Emergency Room Doctor Says, “We Knew It Was Coming”

April 7, 2020 by Dan McCue
Medical technicians handle a vial containing a nasal swab at a drive-thru testing site in Wheat Ridge, Colo., as a statewide stay-at-home order remains in effect in an effort to reduce the spread of the COVID-19 coronavirus. Home testing for coronavirus may sound like a good idea, but As of early April 2020, U.S. regulators say it's still too risky. (AP Photo/David Zalubowski)

WASHINGTON — “We knew it was coming.”

Those were among the first words uttered by a young emergency room doctor when reached by The Well News earlier this week.

The doctor, who had told his hospital he would be speaking with a reporter, nevertheless asked that his name not be used.

“I am more than happy to talk to you,” he said, going on to explain that to identify him would mean identifying the hospital and that would trigger the bureaucratic red tape that usually went along with staff’s interaction with the media.

It was mutually agreed the state he was speaking from — Utah — could be identified for the sake of context.

With that he began to offer his account of what it’s like to live on the front lines of the coronavirus outbreak.

“Everyone had a warning,” the doctor said. “We had meetings, planning meetings, in February, talking about what had transpired in China in regard to the virus, and what was already beginning to be seen in other places.

“At this point, the potential impact of the coronavirus was still being downplayed by our leaders, but I was personally concerned enough because of what I was hearing, that I started cancelling a bunch of social functions, plans my wife and I and our family had.”

The doctor said the initial response to his caution was, “Really?” “Are you really doing this?”

By now, it was early March. Two days after the doctor cleared his personal schedule, Utah Jazz center Rudy Gobert tested positive for the coronavirus and the NBA suspended its season. A second Jazz player, Donovan Mitchell, also tested positive for the virus. Both have since fully recovered.

“I think that was the real turning point in this crisis,” the doctor said. “That’s when the mood shift occurred. Suddenly, the coronavirus wasn’t a China problem or a Europe problem or an overseas problem, it was our problem.”

Something’s Out There, But We Can’t Test For It

As of Monday, Utah had confirmed 1,675 cases of the coronavirus, out of a total 33,394 people who have been tested, the state health department said.

At least 138 people are hospitalized, and the state says there have been 13 coronavirus deaths.

Asked when the first coronavirus case came into his emergency room, the doctor said he doesn’t really know.

“I mean, I’m 100% sure we saw our first cases in the beginning of March, but we couldn’t test for it then. Shortly after that, tests became more available and we saw our first positive test results. Then some of our physicians got sick, and now I see it every day.”

Statistically speaking, Utah is currently in the middle of the pack in terms of states dealing with the outbreak. The hot spots in the nation continue to be New York City, Seattle, Washington, and parts of California.

“It’s not nearly as bad here, and I’m hoping it won’t get to be,” the doctor said. “The thing is, when we talk to emergency room staff and directors in those states, they keep telling us there’s this weird little calm before the storm.

“I feel like that’s the period we’re in right now, where it’s like, you can feel the tide rising and you know the wave is coming,” he added.

The doctor went on to draw a contrast between the anxiety that feeling creates and what he’s actually seeing in the ER.

“Yes,” he said, he is seeing “sicker” and “sicker” patients suffering from the virus, and he has patients die from it.

But the anticipated tidal wave of patients — what the doctor called, “the overwhelming surge” — has not occurred.

“I’m still expecting it,” he said. “But the question is, how much can we do to flatten the curve and perhaps stave it off? Right now, we’re doing very well in that sense.

“For example, in New York, they were seeing the number of cases double every two to three days. By comparison, our rate of infection has doubled every five or six days, which is fantastic for us, and probably has a lot to do with the relative population density of the two places, and the fact Utah has a relatively healthy population to begin with.”

What followed was a lot of talk about infection rates, mortality rates by age and so on, but the numbers were inexact and were hard to confirm beyond a very general sense.

“What’s frustrating is that there’s just so much that’s unknown because of the lack of initial testing,” the doctor said. “We saw the storm coming and couldn’t do anything about it. And even when we knew it was here, we couldn’t get the tests to confirm what we were seeing.”

“It’s hard to give accurate numbers when you’re kind of flying with one eye closed,” he said.

Best Treatment Right Now, Supportive Care

The doctor said despite all the discussion in the media about treating the coronavirus with the anti-malaria drug Hydroxychloroquine, the “best treatment we know of right now is supportive care.”

“What that means is that in the absence of a proven treatment for the virus itself, you try to provide support against the things the virus is doing to the body,” he said. “For instance, if it impairs your ability to breathe, we can use a variety of tools to overcome that. If it’s dehydrating you, we have ways of addressing that.

“So basically, our approach to treatment is supporting the systems that your body has to try to fight off the virus,” he said.

Like other members of the medical community, the doctor did not dismiss Hydroxychloroquine out of hand, calling it one of several drugs people have said might defeat the virus.

“The problem for many people is the data and literature is just not out there to confirm these claims, which is not unusual with a new virus,” he said.

The doctor then went on to explain that drugs aren’t the only thing doctors are debating on the front lines of the outbreak. Another is when — and whether or not — coronavirus patients should be put on a ventilator.

“By the time people are typically put on a ventilator, they are critically ill and their chances of dying have increased dramatically. The question is, are ventilators actually helping these patients. Some people say they are, and some people say they aren’t.

“And I’ve seen opinions over who needs to be ventilated and who doesn’t shift over time, the net result being it’s unclear exactly when we need to pull the trigger on this kind of treatment,” he said.

While some have suggested the CPAP machines — long the go-to treatment for obstructive sleep apnea — or the similar BiPAP machines could be a useful alternative, but our doctor said they probably are not safe to use with his virus.

For those you are unfamiliar, CPAP machines deliver a steady, continuous stream of pressurized air to patient’s airways to prevent them from collapsing and causing apnea events. BiPAP machines were developed for patients who found it difficult to breathe against the steady pressure. So instead of one constant pressure, the machine can be set to a prescribed pressure for inhaling and a lower pressure for exhaling.

“The problem is, these machines could actually aerosolize the virus and help spread it through the air, endangering the team trying to care for the patient,” the doctor said.

“So that’s another challenge. We’re trying to come up with creative ways to protect ourselves and keep ourselves safe at the same time we’re trying to help a seriously ill patient get well,” he said.

Personal Protection

When it comes to the coronavirus, doctors and nurses and other medical professionals feel the same fear, stress and anxiety as everybody else.

“Oh, we worry,” the doctor said. “I’m very worried about my family and bringing this thing home to them, and I think medical professionals are in a really weird place.

“On the one hand, it’s horrible, and yet you feel privileged to be able to help in this situation,” he continued, adding, the hardest part is “switching back and forth between home and the hospital.”

“It’s hard to get a break from this. And it doesn’t help that the rest of the world has shut down,” he said. “It’s all everyone’s talking about. It’s inescapable on the news. And that adds to the stress,” the doctor said.

“I have a friend, a psychologist, who specializes in PTSD in first responders and the military, and he equates this crisis to a kind of domestic warfare. It’s like, you’re not able to simply flip a switch and be at home and switch it again and be at work. It’s all just a different set of challenges.”

The doctor said he and other professionals at his hospital have begun showering every day before heading home, bringing a change of clothes in a plastic bag.

“I change out of my scrubs, take a shower, try not to touch anything … and I wipe down my phone, even though I’ve carried it around in a plastic bag all day … and as soon as I get home, the clothes go right into the laundry in the garage so they can be decontaminated. Also, my shoes don’t enter the house, ever.

“So we’re doing the best we can, but I’m still nervous about bringing it home, every time my shift at the hospital ends,” he said.

As for the rest of us, the doctor said if you’re following the recommendation to wash your hands, not touch your face, wearing a mask when you go out and isolating as much as possible, then you’re doing everything you can to protect yourself against the virus.

“It’s just a matter of everybody needing to do their part,” he said.

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